Healthcare Provider Details

I. General information

NPI: 1649545252
Provider Name (Legal Business Name): CARDIOVASCULAR HEALTH SPECIALISTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR SUITE 1400
BLOOMINGTON IL
61701-3534
US

IV. Provider business mailing address

1505 EASTLAND DR SUITE 1400
BLOOMINGTON IL
61701-3534
US

V. Phone/Fax

Practice location:
  • Phone: 309-825-6252
  • Fax: 309-663-0008
Mailing address:
  • Phone: 309-825-6252
  • Fax: 309-663-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036076395
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036076395
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number036076395
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036076395
License Number StateIL

VIII. Authorized Official

Name: DR. PATRICK B MURPHY
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 309-825-6252